ALIMA publishes new study to include short children in MAM project

New study shows how to reach more malnourished children with life-saving treatment Results from a study published on January 7, 2016 by the American Journal of Clinical Nutrition, should lead to a marked increase in the number of children receiving life-saving malnutrition treatment, according to the authors from the Alliance for International Medical Action (ALIMA) and the University of Copenhagen (UCPH).

Malnutrition can be diagnosed by measuring a child´s mid-upper arm circumference (MUAC) which reflects the muscle mass of the child. Children with a low MUAC have a high risk of death and should be treated with food supplementation. Today, however, the use of MUAC to determine which children should be treated in many contexts is restricted to children who are taller than a certain height (67 cm, for example.) It has been assumed that children shorter than this cut-off are suffering from stunting, a form of chronic malnutrition, and would not benefit from treatment. The World Health Organization (WHO) had called for research to determine the treatment effect among such shorter children, and this study gives a clear answer, showing that children above and below the height threshold benefit from treatment to the same degree.

“We responded to the WHO´s call for research and found no difference in children’s growth rate above or below a commonly used height cut-off,” said lead author Christian Fabiansen of the Department of Nutrition, Exercise and Sports at the University of Copenhagen. “Simply put, a child’s height should no longer be considered when admitting children by MUAC.”

The observational study analyzed growth data from a cohort of children admitted for treatment of moderate acute malnutrition (MAM) by MUAC as part of the larger TreatFOOD randomized control trial conducted in Burkina Faso from 2013 to 2014. The results could have an immediate impact by both simplifying and expanding the reach of malnutrition treatment programs.

“Using a height restriction for MUAC systematically excludes stunted children who are at considerable risk of death if left untreated,” said Dr. Susan Shepherd, Director of Operational and Medical Research Support for ALIMA. “Ending this practice can save a lot more lives while eliminating an unnecessary step in the admissions process.”

For Professor André Briend of UCPH and the Department for International Health at the University of Tampere School of Medicine, the study has the potential to save thousands of lives by encouraging treatment programs to include these extremely vulnerable young, short children with low MUAC.

“Both wasting and stunting increase a child’s risk of death, especially when both are present in the same child,” said Prof. Briend. “Current practice excludes far too many children who would benefit from treatment and our results suggest that MUAC is a good tool for identifying them.”

Most countries of West and Central Africa, where the burden of acute malnutrition and stunting is among the highest in the world, include a 67 cm cut-off for admission by MUAC in their operational guidelines and national protocols for malnutrition treatment.

“We understand that it takes time for practice to catch up to new evidence,” Dr. Shepherd said. “But it will be vital for the WHO, UNICEF, and Ministries of Health to quickly incorporate these findings in national policies.”